Glucocorticoids, Oral

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PDL Status Values

Y = preferred
N = non-preferred. Non-preferred drugs listed as N but without clinical drug use criteria are subject to the Non-Preferred Drugs in Select PDL Classes prior authorization criteria. New drugs will be listed as N until reviewed by the P&T Committee and are subject to the New Drug Policy.
V = voluntary non-preferred. Non-preferred mental health drugs are listed as V and prior authorization is not required but eligible patients will encounter a co-pay at the pharmacy.
Null (i.e. blank) = indicates the class or specific drug has not been reviewed for PDL placement.

To request a Prior Authorization, please use this form.

Generic Name Brand Name Form PDL
Status
Current Drug Use Criteria New Drug Evaluation
BUDESONIDE BUDESONIDE EC CAPDR - ER Y    
BUDESONIDE ENTOCORT EC CAPDR - ER Y    
CORTISONE ACETATE CORTISONE ACETATE TABLET    
DEFLAZACORT EMFLAZA ORAL SUSP PA Document  
DEFLAZACORT EMFLAZA TABLET PA Document Jul 27, 2017
DEXAMETHASONE DEXAMETHASONE INTENSOL DROPS    
DEXAMETHASONE DEXAMETHASONE ELIXIR    
DEXAMETHASONE DEXAMETHASONE SOLUTION    
DEXAMETHASONE DEXPAK TAB DS PK    
DEXAMETHASONE DEXAMETHASONE TABLET    
HYDROCORTISONE CORTEF TABLET    
HYDROCORTISONE HYDROCORTISONE TABLET    
METHYLPREDNISOLONE MEDROL TAB DS PK    
METHYLPREDNISOLONE METHYLPREDNISOLONE TAB DS PK    
METHYLPREDNISOLONE MEDROL TABLET    
METHYLPREDNISOLONE METHYLPREDNISOLONE TABLET    
PREDNISOLONE PREDNISOLONE SOLUTION    
PREDNISOLONE MILLIPRED DP TAB DS PK    
PREDNISOLONE MILLIPRED TABLET    
PREDNISOLONE SOD PHOSPHATE VERIPRED 20 SOLUTION    
PREDNISOLONE SOD PHOSPHATE PREDNISOLONE SODIUM PHOSPHATE SOLUTION    
PREDNISOLONE SOD PHOSPHATE PEDIAPRED SOLUTION    
PREDNISOLONE SOD PHOSPHATE MILLIPRED SOLUTION    
PREDNISOLONE SOD PHOSPHATE PREDNISOLONE SODIUM PHOS ODT TAB RAPDIS    
PREDNISOLONE SOD PHOSPHATE ORAPRED ODT TAB RAPDIS    
PREDNISONE PREDNISONE INTENSOL ORAL CONC    
PREDNISONE PREDNISONE SOLUTION    
PREDNISONE PREDNISONE TAB DS PK    
PREDNISONE PREDNISONE TABLET    
PREDNISONE RAYOS TABLET DR